Clinical Effect of Yinhuang Qingfei Capsules in Treatment of Asymptomatic and Mild/Common Severe Acute Respiratory Syndrome Coronavirus 2 Infection:An Analysis of 242 Cases

[Objectives]To investigate the clinical effect of Yinhuang Qingfei capsules in the treatment of asymptomatic and mild/common severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.[Methods]A total of 362 patients with SARS-CoV-2 infection were divided into the treatment group with 242 patients and control group with 120 patients according to their treatment regimen.The patients in the control group were given standard treatment regimen and those in the treatment group were given Yinhuang Qingfei capsules in addition to the treatment in the control group.The two groups were observed in terms of average length of hospital stay,mean time for nucleic acid clearance,TCM syndrome score,and progression to severe/critical illness,and clinical outcome was compared between the two groups.[Results]There was a significant difference in the overall response rate between the treatment group and the control group[97.52%(236/242)vs 95.00%(114/120),P<0.05].Compared with the control group,the treatment group had significantly shorter length of hospital stay and time for nucleic acid clearance(P<0.05).After 7 days of treatment,both groups had a significant change in TCM syndrome score,and there was a significant difference in TCM syndrome score between the two groups(P<0.05);after 15 days of treatment,both groups had a TCM syndrome score of 0.Progression to severe/critical illness was not observed in either group.[Conclusions]Compared with the standard treatment regimen alone,standard treatment regimen combined with Yinhuang Qingfei capsules can effectively shorten the length of hospital stay and time for nucleic acid clearance and improve TCM symptoms in patients with asymptomatic and mild/common SARS-CoV-2 infection.

A six-year descriptive epidemiological study of human coronavirus infections in hospitalized patients in Hong Kong

We conducted a six-year epidemiological study on human coronaviruses（HCoVs） circulating in Hong Kong, using 8275 nasopharyngeal samples from patients with acute respiratory tract infections. HCoVs were detected in 77（0.93%） of the samples by a pan-HCoV RT-PCR assay. The most frequently detected HCoV species was HCoV-OC43（0.58%）, followed by HCoV-229E（0.15%）,HCoV-HKU1（0.13%） and HCoV-NL63（0.07%）. HCoVs were detected throughout the study period（September 2008–August 2014）, with the highest detection rate from September 2010 to August2011（22/1500, 1.47%）. Different seasonal patterns of each HCoV species in Hong Kong were noted.HCoV-OC43 was predominant in the fall and winter, whereas HCoV-HKU1 showed peak activity in winter, with a few cases occurred in spring and summer. HCoV-229 E mainly occurred in winter and spring, while HCoV-NL63 was predominant in summer and autumn. HCoVs most commonly infect the elderly and young children, with median age of 79.5 years（range, 22 days to 95 years）.Intriguingly, the detection rate of HCoV-OC43 in the age group of ＆gt; 80 years（26/2380, 1.09%） was significantly higher than that in the age group of 0–10 years（12/2529, 0.47%）（P 〈 0.05）. These data provides new insight into the epidemiology of coronaviruses.

Hepatobiliary system and intestinal injury in new coronavirus infection(COVID-19):A retrospective study

BACKGROUND An important area of effective control of the coronavirus disease 19(COVID-19)pandemic is the study of the pathogenic features of severe acute respiratory syndrome coronavirus 2 infection,including those based on assessing the state of the intestinal microbiota and permeability.AIM To study the clinical features of the new COVID-19 in patients with mild and moderate severity at the stage of hospitalization,to determine the role of hepatobiliary injury,intestinal permeability disorders,and changes in the qualitative and quantitative composition of the microbiota in the development of systemic inflammation in patients with COVID-19.METHODS The study was performed in 80 patients with COVID-19,with an average age of 45 years,19 of whom had mild disease,and 61 had moderate disease severity.The scope of the examination included traditional clinical,laboratory,biochemical,instrumental,and radiation studies,as well as original methods for studying microbiota and intestinal permeability.RESULTS The clinical course of COVID-19 was studied,and the clinical and biochemical features,manifestations of systemic inflammation,and intestinal microbiome changes in patients with mild and moderate severity were identified.Intestinal permeability characteristics against the background of COVID-19 were evaluated by measuring levels of proinflammatory cytokines,insulin,faecal calprotectin,and zonulin.CONCLUSION This study highlights the role of intestinal permeability and microbiota as the main drivers of gastroenterological manifestations and increased COVID-19 severity.

Cold exposure promotes coronavirus infection by altering the gut microbiota and lipid metabolism to reduce host immunity

Objective:Cold exposure has been suggested to be advantageous for the spread and infection of the coronavirus,and the gut microbiota influences the severity of the infection by modulating host inflammatory and immune responses.However,it remains unclear whether the promotion of viral infection through cold exposure is linked to the gut microbiota.Methods:In this study,we performed an unbiased analysis of gut microbiota,serum,and lung tissue metabolome changes in cold-exposed and virus-infected mice,alongside the assessment of immune-inflammatory indicators in serum and lung tissue.Results:The results revealed that both cold exposure and viral infection significantly decreased the percentage of peripheral blood lymphocytes(CD4^(+)T cells,CD8^(+)T cells,and B cell)and increased the expression of inflammatory factors(IL-6,IL-1β,TNF-α,and IFN-γ).Meanwhile,cold exposure disrupted the homeostasis of gut microbiota,elevating the abundance of pathogenic bacteria(Staphylococcus)and diminishing the abundance of beneficial bacteria(Alistipes).Notably,in virus-infected mice exposed to a cold environment,the reduction in the abundance of beneficial bacteria Alistipes was more pronounced than in cases of single virus infection and cold exposure.Analysis of altered serum and lung tissue metabolites highlighted glycerophospholipids,fatty acids,and eicosanoids as the most affected metabolites by cold exposure.These metabolites,closely associated with virus infection,exhibited a significant correlation with immune-inflammatory indicators.Conclusion:These findings establish a mechanistic connection between cold exposure and virus infection,suggesting that cold exposure-induced dysregulation of gut microbiota and lipid metabolism diminishes host immunity,promoting virus infection.

Diabetes Risk Factor and Its Relationship to Increasing Coronavirus (COVID-19) Mortality Rate in United States in 2019-2022: An Epidemiological Study

As an effort to understand the effect of diabetes on the increasing rate of COVID-19 infection, we embarked upon a detailed statistical analysis of various datasets that include COVID-19 infection and mortality rate, diabetes and diseases that may contribute to the severity and risk factor of diabetes in individuals and this impact on COVID-19 and the mortality rate. These diseases include respiratory diseases, cardiovascular diseases, and obesity. Equally significant is the statistical analysis on ethnicity, age, and sex on COVID-19 infection as well as mortality rate. Their possible contributions to increasing the severity and risk factor of diabetes as a risk to mortality to individuals who have COVID-19. Objectives: The ultimate objectives of this investigation are as follow: 1) Is there a risk factor of diabetes on COVID-19 infection and increasing mortality rate? 2) To what extent do other disease conditions that include, obesity, heart failure, and respiratory diseases influence the severity and risk factor of diabetes on increasing COVID-19 infection and mortality rate? 3) To what extent does age, race, and gender increase the mortality of COVID-19 and increase the severity and risk factor of diabetes on COVID-19 mortality rate? 4) How and why COVID-19 virus increases the risk of diabetes in children? 5) Diabetes and COVID-19: Who is most at Risk? Lastly, understanding the misconception of COVID-19 and diabetes.

Subdural effusion associated with COVID-19 encephalopathy: A case report

BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory and gustatory deficits,hallucinations,and headache)to severe complications(e.g.,stroke,seizures,encephalitis,and neurally demyelinating lesions).The occurrence of single-pass subdural effusion,as described below,is extremely rare.CASE SUMMARY A 56-year-old male patient presented with left-sided limb weakness and slurred speech as predominant clinical symptoms.Through comprehensive imaging and diagnostic assessments,he was diagnosed with cerebral infarction complicated by hemorrhagic transformation affecting the right frontal,temporal,and parietal regions.In addition,an intracranial infection with SARS-CoV-2 was identified during the rehabilitation process;consequently,an idiopathic subdural effusion developed.Remarkably,the subdural effusion underwent absorption within 6 d,with no recurrence observed during the 3-month follow-up.CONCLUSION Subdural effusion is a potentially rare intracranial complication associated with SARS-CoV-2 infection.

Prevalence and prognosis of acute pancreatitis in critically ill patients with COVID-19

Background:Coronavirus disease 2019(COVID-19)is a global pandemic issue.In addition to the well-known respiratory and fever symptoms,gastrointestinal symptoms have also been reported.This study aimed to evaluate the prevalence and prognosis of patients with COVID-19 infection complicated with acute pancreatitis in intensive care unit(ICU).Methods:This was a retrospective observational cohort study,and patients aged 18 years or older,ad-mitted into the ICU in a single tertiary center from January 1,2020,to April 30,2022 were enrolled.Patients were identified by electronic medical records and reviewed manually.The primary outcome was the prevalence of acute pancreatitis among ICU patients with COVID-19.The secondary outcomes were the length of hospital stay,need for mechanical ventilation(MV),need for continuous renal replacement therapy(CRRT),and in-hospital mortality.Results:A total of 4133 patients,admitted into the ICU,were screened.Among these patients,389 were infected by COVID-19,and 86 were diagnosed with acute pancreatitis.COVID-19 positive patients were more likely to present with acute pancreatitis than COVID-19 negative patients(odds ratio=5.42,95%confidence interval:2.35-6.58,P<0.01).However,the length of hospital stay,need for MV,need for CRRT,and in-hospital mortality were not significantly different between acute pancreatitis patients with and without COVID-19 infection.Conclusions:Severe COVID-19 infections may cause acute pancreas damage in critically ill patients.How-ever,the prognosis may not differ between acute pancreatitis patients with and without COVID-19 infec-tion.

A reflection on the anti-epidemic response of COVID-19 from the perspective of disaster management

The outbreak of coronavirus disease 2019(COVID-19)shocked the world as it spread rapidly from continent to continent,and finally,it became a pandemic resulting in many infected patients,with an increasing number of deaths,and a devastating effect on worldwide economics.People only know that epidemic or pandemic is a rapid spread of infection,but in fact it can also be regarded as a biological disaster,which can be managed from a perspective of disaster management.This article discusses the current situation of the anti-epidemic response of COVID-19,and suggests using a disaster management approach to better handle this pandemic situation through mitigation,preparedness,response and recovery.

Predictive value of serum cystatin C for risk of mortality in severe and critically ill patients with COVID-19

BACKGROUND The outbreak of coronavirus disease 2019(COVID-19)has rapidly evolved into a global pandemic.COVID-19 is clinically categorized into mild,moderate,severe,and critical illness.Acute kidney injury is an independent risk factor for poor prognosis in patients with.Serum cystatin C(s Cys C)is considered a more sensitive biomarker for early renal insufficiency than conventional indicators of renal function.Early detection of risk factors that affect the prognosis of severe and critically ill patients while using active and effective treatment measures is very important and can effectively reduce the potential mortality rate.AIM To determine the predictive value of s Cys C for the prognosis of patients with COVID-19.METHODS The clinical data of 101 severe and critically ill patients with COVID-19 at a designated hospital in Wuhan,Hubei Province,China were analyzed retrospectively.According to the clinical outcome,the patients were divided into a discharge group(64 cases)and a death group(37 cases).The general information,underlying diseases,and laboratory examination indexes of the two groups were compared.Multivariate Cox regression was used to explore the relationship between s Cys C and prognosis.The receiver operating characteristic(ROC)curve was used to demonstrate the sensitivity and specificity of s Cys C and its optimal cut-off value for predicting death.RESULTS There were significant differences in age,s Cys C,creatinine,C-reactive protein,serum albumin,creatine kinase-MB,alkaline phosphatase,lactate dehydrogenase,neutrophil count,and lymphocyte count between the two groups(P<0.001).Multivariate logistic regression analysis showed that s Cys C was an independent risk factor for death in patients with COVID-19(Odds ratio=1.812,95%confidence interval[CI]:1.300-2.527,P<0.001).The area under the ROC curve was 0.755(95%CI:1.300-2.527),the cut-off value was 0.80,the specificity was 0.562,and the sensitivity was 0.865.CONCLUSION s Cys C is an independent risk factor for death in patients with COVID-19.Patients with a s Cys C level of 0.80 mg/L or greater are at a high risk of death.

Effect of methylprednisolone in severe and critical COVID-19:Analysis of 102 cases

BACKGROUND The coronavirus disease 2019(COVID-19)outbreak has brought great challenges to public health.Aggravation of COVID-19 is closely related to the secondary systemic inflammatory response.Glucocorticoids are used to control severe diseases caused by the cytokine storm,owing to their anti-inflammatory effects.However,glucocorticoids are a double-edged sword,as the use of large doses has the potential risk of secondary infection and long-term serious complications,and may prolong virus clearance time.Nonetheless,the risks and benefits of glucocorticoid adjuvant therapy for COVID-19 are inconclusive.AIM To determine the effect of methylprednisolone in severe and critically ill patients with COVID-19.METHODS This single-center retrospective study included 102 adult COVID-19 patients admitted to a ward of a designated hospital in Wuhan,Hubei Province from January to March 2020.All patients received general symptomatic treatment and organ function support,and were given different respiratory support measures according to their conditions.In case of deterioration,considering the hyperinflammatory state of the patients,methylprednisolone was intravenously administered at 0.75-1.5 mg/kg/d,usually for less than 14 d.Patient vital signs and oxygenation were closely monitored,in combination with imaging and routine blood tests such as C-reactive protein,biochemical indicators(liver and kidney function,myocardial enzymes,electrolytes,etc.),and coagulation function.Patient clinical outcomes were discharge or death.RESULTS A total of 102 severe and critically ill COVID-19 patients were included in this study.They were divided into treatment(69,67.6%)and control groups(33,32.4%)according to methylprednisolone use.Comparison of baseline data between the two groups showed that the treatment group patients had higher aspartic acid aminotransferase,globulin,hydroxybutyrate dehydrogenase,and lactate dehydrogenase.There was no significant difference in other baseline data between the two groups.With regard to prognosis,29(78.4%)patients in the treatment group died as opposed to 40(61.5%)in the control group.The mortality was higher in the treatment group than in the control group;however,according to the log-rank test and the Kaplan–Meier survival curve,the difference in mortality between both groups was insignificant(P=0.655).The COX regression equation was used to correct the variables with differences,and the results showed that methylprednisolone treatment did not improve prognosis.CONCLUSION Methylprednisolone treatment does not improve prognosis in severe and critical COVID-19 patients.

Considerations about Timing to Perform Elective Tracheostomies in Patients Hospitalized in COVID-19 Units

Since the beginning of the pandemic caused by the new Coronavirus (SARS- CoV-2), critically ill patients care has been challenging. It is necessary to perform the best available practice and protect the health team, preserving human resources and rationalizing costs. Changes in tracheostomies institutional protocols are necessary according to each health care services reality. This is particular important in developing countries. The aim of this study is to establish a practical and sucint guideline to minimize controversies regarding the proper timing to perform elective tracheostomies in critically ill coronavirus infected patients.

COVID-19:A review of what radiologists need to know

Coronavirus disease-2019(COVID-19)is spreading throughout the world.Chest radiography and computed tomography play an important role in disease diagnosis,differential diagnosis,severity evaluation,prognosis prediction,therapeutic effects assessment and follow-up of patients with COVID-19.In this review,we summarize knowledge of COVID-19 pneumonia that may help improve the abilities of radiologists to diagnose and evaluate this highly infectious disease,which is essential for epidemic control and preventing new outbreaks in the short term.

Circulating angiotensin converting enzyme 2 and COVID-19

The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has triggered a widespread outbreak since December 2019.The SARS-CoV-2 infection-related illness has been dubbed the coronavirus disease 2019(COVID-19)by the World Health Organization.Asymptomatic and subclinical infections,a severe hyperinflammatory state,and mortality are all examples of clinical signs.After attaching to the angiotensin converting enzyme 2(ACE2)receptor,the SARSCoV-2 virus can enter cells through membrane fusion and endocytosis.In addition to enabling viruses to cling to target cells,the connection between the spike protein(S-protein)of SARS-CoV-2 and ACE2 may potentially impair the functionality of ACE2.Blood pressure is controlled by ACE2,which catalyzes the hydrolysis of the active vasoconstrictor octapeptide angiotensin(Ang)II to the heptapeptide Ang-(1-7)and free L-Phe.Additionally,Ang I can be broken down by ACE2 into Ang-(1-9)and metabolized into Ang-(1-7).Numerous studies have demonstrated that circulating ACE2(cACE2)and Ang-(1-7)have the ability to restore myocardial damage in a variety of cardiovascular diseases and have antiinflammatory,antioxidant,anti-apoptotic,and anti-cardiomyocyte fibrosis actions.There have been some suggestions for raising ACE2 expression in COVID-19 patients,which might be used as a target for the creation of novel treatment therapies.With regard to this,SARS-CoV-2 is neutralized by soluble recombinant human ACE2(hrsACE2),which binds the viral S-protein and reduces damage to a variety of organs,including the heart,kidneys,and lungs,by lowering Ang II concentrations and enhancing conversion to Ang-(1-7).This review aims to investigate how the presence of SARS-CoV-2 and cACE2 are related.Additionally,there will be discussion of a number of potential therapeutic approaches to tip the ACE/ACE-2 balance in favor of the ACE-2/Ang-(1-7)axis.

Effect of drug therapies on self-reported chemosensory outcomes after COVID-19

Objective:The aim of this study was to assess the relative efficacy of medications used following severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection on self-reported alterations in taste and/or smell function.Methods:Seven hundred and fourteen persons with self-reported postcoronavirus disease 2019(post-COVID-19)chemosensory disorders were personally interviewed regarding specific medications they were administered following the acute phase of the disease.The dependent measure—self-reported total recovery of chemosensory symptoms—was subjected to stepwise logistic regression.Independent predictors included demographic and clinical variables,in addition to specific medications used to mitigate disease symptoms(i.e.,systemic corticosteroids,oseltamivir,vitamin C,ibuprofen,hydroxychloroquine,azithromycin,ivermectin,nitazoxanide,anticoagulants,and zinc).Results:The median time between COVID-19 symptom onset and the interviews was 81 days(interquartile range:60-104).Of the 714 subjects,249(34.9%)reported total recovery of their chemosensory function;437(61.2%)had at least one treatment since the beginning of the disease.Women and those with more comorbidities had undergone more treatments.The recovery rates of the treated and nontreated groups did not differ significantly.Nonetheless,respondents who had used nitazoxanide tended to have a higher rate of self-reported taste or smell recovery.Those who took oral zinc were less likely to improve.Conclusions:No medication employed during the first months after SARS-CoV-2 infection had a clear positive effect on returning self-reported smell or taste function to normal,although nitrazoxide trended in a positive direction.Oral zinc had a negative effect on the reported recovery of these senses.

Expert Consensus on the Clinical Application of Oral Small-molecule Antiviral Drugs Against COVID-19

Although COVID‑19 no longer constitutes a“public health emergency of international concern”,which still has being spreading around the world at a low level.Small molecule drugs are the main antiviral treatment for novel coronavirus recommended in China.Although a variety of small‑molecule antiviral drugs against COVID‑19 have been listed in China,there is no specific drug recommendation for special populations.Society of Bacterial Infection and Resistance of Chinese Medical Association,together with the National Clinical Research Center for Respiratory Disease,and the National Center for Respiratory Medicine,organized domestic experts in various fields such as respiratory,virology,infection,critical care,emergency medicine and pharmacy to release Expert Consensus on the Clinical Application of Oral Small‑Molecule Antiviral Drugs against COVID‑19.The main content of this consensus includes the introduction of seven small‑molecule antiviral drugs against COVID‑19,focusing on the drug recommendations for 14 special groups such as the elderly,patients with complicated chronic diseases,tumor patients,pregnant women,and children,and providing suggestions for clinicians to standardize drug use.

Pay attention to situation of SARS-CoV-2 and TCM advantages in treatment of novel coronavirus infection

Since the outbreak of the new coronavirus epidemic,novel coronavirus has infected nearly 100,000 people in more than 110 countries.How to face this new coronavirus epidemic outbreak is an important issue.Basic reproduction number(R0)is an important parameter in epidemiology;The basic reproduction number of an infection can be thought of as the expected number of cases directly generated by one case in a population where all individuals are susceptible to infection.Epidemiology dynamics is a mathematical model based on a susceptibility-infection-recovery epidemic model.Researchers analyzed the epidemiological benefits of different transmission rates for the establishment of effective strategy in prevention and control strategies for epidemic infectious diseases.In this review,the early use of TCM for light and ordinary patients,can rapidly improve symptoms,shorten hospitalization days and reduce severe cases transformed from light and normal.Many TCM formulas and products have wide application in treating infectious and non-infectious diseases.The TCM theoretical system of treating epidemic diseases with TCM and the treatment scheme of integrated Chinese and Western medicine have proved their effectiveness in clinical practice.TCM can cure COVID-19 pneumonia,and also shows that the role of TCM in blocking the progress of COVID-19 pneumonia.

Coronavirus: epidemiology, genome replication and the interactions with their hosts

This special issue of the journal is dedicated to the recent progress on coronaviruses and covers the topics of viral epidemiology,virus replication and the interactions between the coronaviruses and their hosts.Members of the family Coronaviridae infect a wide range of vertebrates and humans.

Persistent alterations in gray matter in COVID-19 patients experiencing sleep disturbances:a 3-month longitudinal study

Sleep disturbances are among the most prevalent neuropsychiatric symptoms in individuals who have recovered from severe acute respiratory syndrome coronavirus 2 infections.Previous studies have demonstrated abnormal brain structures in patients with sleep disturbances who have recovered from coronavirus disease 2019(COVID-19).However,neuroimaging studies on sleep disturbances caused by COVID-19 are scarce,and existing studies have primarily focused on the long-term effects of the virus,with minimal acute phase data.As a result,little is known about the pathophysiology of sleep disturbances in the acute phase of COVID-19.To address this issue,we designed a longitudinal study to investigate whether alterations in brain structure occur during the acute phase of infection,and verified the results using 3-month follow-up data.A total of 26 COVID-19 patients with sleep disturbances(aged 51.5±13.57 years,8 women and 18 men),27 COVID-19 patients without sleep disturbances(aged 47.33±15.98 years,9 women and 18 men),and 31 age-and gender-matched healthy controls(aged 49.19±17.51 years,9 women and 22 men)were included in this study.Eleven COVID-19 patients with sleep disturbances were included in a longitudinal analysis.We found that COVID-19 patients with sleep disturbances exhibited brain structural changes in almost all brain lobes.The cortical thicknesses of the left pars opercularis and left precuneus were significantly negatively correlated with Pittsburgh Sleep Quality Index scores.Additionally,we observed changes in the volume of the hippocampus and its subfield regions in COVID-19 patients compared with the healthy controls.The 3-month follow-up data revealed indices of altered cerebral structure(cortical thickness,cortical grey matter volume,and cortical surface area)in the frontal-parietal cortex compared with the baseline in COVID-19 patients with sleep disturbances.Our findings indicate that the sleep disturbances patients had altered morphology in the cortical and hippocampal structures during the acute phase of infection and persistent changes in cortical regions at 3 months post-infection.These data improve our understanding of the pathophysiology of sleep disturbances caused by COVID-19.

Translation:Management of Coronavirus Disease 2019(COVID-19):Experience in Zhejiang Province,China

The current epidemic situation of coronavirus disease 2019(COVID-19)still remains severe.As the National Clinical Research Center for Infectious Diseases,The First Affiliated Hospital of the Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang Province.Based on the present expert consensus carried out by the National Health Commission and National Administration of Traditional Chinese Medicine,our team summarized and established an effective treatment strategy centered on“Four-Anti and Two-Balance”for clinical practice.The“Four-Anti and Two-Balance”strategy includes antivirus,anti-shock,antihypoxemia,and anti-secondary infection,and maintaining of water,electrolyte and acid/base balance and microecological balance.Simultaneously,an integrated multidisciplinary personalized treatment is recommended to improve therapeutic effects.The importance of early viral detection,dynamic monitoring of inflammatory indexes,and chest radiographs has been emphasized in clinical decision-making.Sputum was observed with the highest positive rate by reverse transcription-polymerase chain reaction(RTPRC).Viral nucleic acids could be detected in 10%of the patients’blood samples at the acute phase and 50%of patients had positive RT-PCR results in their feces.We also isolated live viral strains from feces,indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identify cytokine storms and for the application of the artificial liver blood purification system.The“Four-Anti and Two-Balance”strategy effectively increased cure rates and reduced mortality.Early antiviral treatment alleviated disease severity and prevented illness progression.We found that lopinavir/ritonavir combined with abidol showed antiviral effects against COVID-19.Shock and hypoxemia were usually caused by cytokine storms.The artificial liver blood purification system was able to rapidly remove inflammatory mediators and block the cytokine storm.Moreover,it also contributed to the balance of fluids,electrolytes,and acids/bases and thus improved treatment efficacy during critical illness.For cases of severe illness,early and also short periods of moderate glucocorticoid administration was supported.Patients with an oxygenation index below 200mmHg were transferred to the intensive care unit.Conservative oxygen therapy was preferred and noninvasive ventilation(NIV)was not recommended.Patients with mechanical ventilation were strictly supervised with cluster ventilator-associated pneumonia prevention strategies.Antimicrobial prophylaxis was prescribed rationally and was not recommended,except for patients with a long course of disease,repeated fever,and elevated procalcitonin,similarly secondary fungal infections were of concern.Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased genus such as Lactobacillus and Bifidobacterium.Nutritional and gastrointestinal function should;therefore,be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infections due to bacterial translocation.Anxiety and fear were common in patients with COVID-19.Therefore,we established a dynamic assessment and warning for psychological crises.We also integrated Chinese medicine in the treatment to promote rehabilitation.We optimized nursing processes for severe patients to promote their rehabilitation.Since viral clearance patterns after severe acute respiratory syndrome coronavirus 2 infections remained unclear,2 weeks quarantine for discharged patients was required,and a regular following-up was also needed.These Zhejiang experiences and suggestions have been implemented in our center and achieved good results.However,since COVID-19 was a newly emerging disease,more work is warranted to further improve strategies of prevention,diagnosis,and treatment for COVID-19.

Clinical characteristics of COVID-19 hospitalized patients associated with mortality:A cohort study in Spain

Background:The heterogeneity of patients with COVID-19 may explain the wide variation of mortality rate due to the population characteristics,presence of comorbidities and clinical manifestations.Methods:In this study,we analyzed 5342 patients’recordings and selected a cohort of 177 hospitalized patients with a poor prognosis at an early stage.We assessed during 6 months their symptomatology,coexisting health conditions,clinical measures and health assistance related to mortality.Multiple Cox proportional hazards models were built to identify the associated factors with mortality risk.Results:We observed that cough and kidney failure triplicate the mortality risk and both bilirubin levels and oncologic condition are shown as the most associated with the demise,increasing in four and ten times the risk,respectively.Other clinical characteristics such as fever,diabetes mellitus,breathing frequency,neutrophil-lymphocyte ratio,oxygen saturation,and troponin levels,were also related to mortality risk of in-hospital death.Conclusions:The present study shows that some symptomatology,comorbidities and clinical measures could be the target of prevention tools to improve survival rates.